E/M Billing: OIG Targets Facilities That Bill E/Ms Which Should Have Been Included in Procedures

Why This Topic Matters

Understanding this topic can help facilities reduce avoidable overpayments, audit exposure, and claim denials related to E/M services reported around procedures. It is especially relevant for organizations reviewing documentation, payer policy alignment, and compliance workflows.

Article Sections

1. OIG audit findings and hospital billing risk

   Summarizes the audit context and the type of hospital claim issues identified. Focuses on the compliance concern and the operational circumstance described in the article.

2. Check This Tip for Procedure-Day E/M

   Discusses general considerations for reporting evaluation and management services on or near a procedure date. Covers the broader compliance topic and references national coding guidance.

3. Alternative

   Notes that payer-specific policies may differ for certain E/M services during a procedure global period. Emphasizes the need to verify instructions with the payer and retain supporting documentation.